A150 IS FOCAL ACTIVE COLITIS OF GREATER SIGNIFICANCE IN PEDIATRIC PATIENTS? A RETROSPECTIVE REVIEW OF 68 CASES WITH CLINICAL CORRELATION.
Bibliographic record
Abstract
Background: Focal active colitis (FAC) is a histopathologic finding of uncertain clinical significance in individual patients. In adult cases, infection accounts for approx. 50%, Crohn's disease (CD) for 0-13%, and 20-30% are idiopathic (likely related to bowel preparation). One previous study of 29 cases of pediatric FAC showed a 28% rate of CD. Histologic features to distinguish between idiopathic FAC and inflammatory bowel disease (IBD) related FAC have not been determined. Aims: Our study aimed to review a large cohort of pediatric patients with FAC to determine what proportion of them had IBD, and whether there was an amount or pattern of inflammation that predicted IBD. Methods: Sixty eight biopsy sets from 68 patients aged 18 years with FAC were identified and reviewed retrospectively. Patients with a prior diagnosis of IBD or chronic colitis in the index biopsies were excluded. Original slides were assessed for a number of inflammatory criteria. Clinical data including presenting symptoms, medication history and final diagnoses were recorded. Data were analysed using Pearson correlations and Fisher's exact chi-square analyses. Results: Sixteen patients (24%) had a final diagnosis of IBD. When cases with terminal ileal inflammation and / or granulomas were excluded 6 of 54 remaining patients had a final diagnosis of IBD (11%). A final diagnosis of IBD was significantly associated with the presence of crypt abscesses in patients with and without terminal ileal inflammation (Fisher's exact=5.67, p=0.027 and Fisher's exact=7.99, p=0.025) and the presence of one or more elevated serum inflammatory markers (Fisher's exact=11.44, p=0.001 and Fisher's exact=15.02, p=0.001). IBD was significantly associated with TI inflammation (Fisher's exact=20.27, p<0.001). An amount or pattern of inflammation that could be used to predict IBD was not determined. Conclusions: In keeping with the previous pediatric study, this study demonstrated a 24% rate of IBD in pediatric patients with FAC; however, when patients with associated terminal ileal inflammation and / or granulomas were excluded, the rate was 11%, similar to the reported rates in adults. When TI inflammation is present in association with FAC there is a high probability of IBD (10/14 cases, 71%). In all patients, the presence of crypt abscesses or increased serum inflammatory markers is associated with a higher likelihood of IBD. In pediatric patients whose biopsies show FAC without terminal ileal inflammation, the clinical implications appear to be the same as those in the adult population and do not warrant more aggressive follow up.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".